American Specialty Health

[Guest guest]

Has anyone signed up with American Specialy Health and either a) stayed

because they love it or b) left because it was the worst thing since

mold or c) any option in the middle I haven't thought of. I'd love to

hear any opinions, positive or negative, either on list or privately.

 

I'm on the fence about signing up with them; and speaking with local

colleagues hasn't helped much since it's been pretty much 50/50 but no

one on either side of the question has offerred much information about

why they go one way or another. Some of the items in the ASH paperwork

have made me sit up and say " why does a health insurance provider need

this info? " so I'm still vacillating.

 

Thanks in advance for any and all answers.

 

Dia

 

Dia Vickery, PhD(Theology), LAc

Licensed Acupuncturist / Herbalist

Ordained Clergy

[Guest guest]

, " Dia Vickery " <moonwillow wrote:

>

>

> Has anyone signed up with American Specialy Health and either a) stayed

> because they love it or b) left because it was the worst thing since

> mold or c) any option in the middle I haven't thought of. I'd love to

> hear any opinions, positive or negative, either on list or privately.

 

I signed up with them years ago, when they first started ten years or so ago. It

was a simple procedure then, and reimbursement was pretty good. I took a three

year sabbatical, and, upon returning to practice this year, I tried signing up

again.

My comments:

1. Reimbursement rates have not increased in 10+ years, averaging $40-50 per

session, including all modalities performed--cupping, moxa, tuina, exercise.

2. The requirements, i.e. paperwork, has gone through the roof.

3. I signed up to accommodate my previous clients with insurance coverage, only

to find that many of the insurance plans have dropped coverage, or pay such

little amounts after increasing copays, co insurance, it is hardly worth the

hassle of billing.

4. American Specialty Health has a 30+ page document to follow to determine if

the treatment falls under acceptable clinical guidelines. I think if I truly

followed this, it would consume the entire treatment session. And, I can see

that at any time they could deny care under this complexity of clinical

judgments and evaluations, or require documentation--another time/money suck.

The basic idea is that the practitioner has 6 treatments to 'cure' the pain

issue. No treatment can be performed that increases the body's function, or is

preventative care. No pain issue can be treated that has an emotional cause,

i.e. stress, that is a major cause in my practice.

5. The requirement that I found the most repulsive, is a long list of medical

procedures that you are required not to do, even if the client pays for it

privately. An example is Reiki. The reasoning is that because this has no proven

medical value, by performing it on a patient, it is considered injurious and

dangerous. You are considered to be leading the patient astray. By following

their clinical guidelines one is reduced to a TCM technician, doing a procedure

of sticking needles into patients in a mechanistic manner.

 

I personally find, on average, patients heal much quicker when they pay cash.

They are more motivated to do the 'homework' I give them, and to try to change

injurious habits. I try to self empower my patients, so they do not become

dependent on a doctor.

Another reason I dislike insurance is that I'm a stickler for privacy, and when

someone tells me of weird or socially unacceptable behaviors or drug usage, I

don't want that entering an insurance database.

 

I'd be interested in how others feel about accepting insurance.

 

Sincerely,

Ronald Holmes LAc.

[Guest guest]

I signed up with ASH because I am a recent licensee (March 08) and I needed to

increase my patient numbers. I have found that ASH is rather easy to deal with,

and by and large I get paid quickly. The payment for acupuncture isn't very

high, and they don't cover anything and surprisingly from what I read in the

previous post, the reimbursement rates haven't kept pace with inflation or cost

of living increases.

 

Most of the ASH patients I get here in San Diego are from Kaiser. They have a

program for referrals through there pain management/physical medicine

department. They will dole out 6 visits and do a re-eval then another 6 visits

if progress is being shown. Alternatively, Kaiser patients can self refer and

get a 25% discount off of U & C fees. There aren't too many solely ASH patients

that I see, most are other insurances which contract with ASH to manage their

acupuncture benefits.

 

I believe that ASH has lots of new practitioners, like myself, however, Kaiser

specifically tells their acupuncture referral patients to find practitioners who

don't just have one year of experience. Good luck!

 

My bottom line advice is: you take ASH because you have to, not because you want

to. I am not currently seeing enough patients so I need to take what I can get,

until I can build my practice.

[Guest guest]

One other note about ASH...I almost signed up even after hearing a lot of

problems and complaints from my colleagues up here in Seattle but then quickly

backed off. The reason was they wanted me to state that I would not use direct

moxa or intradermal needles (this includes ear needle tacks). They even had

their MD advisor call me on this issue who said these techniques were dangerous

and potentially unsanitary. (I asked him what the difference between our

intradermal needle technique and their taping a hyperdermic needle in a

patient's arm or neck for days but didn't get a great response.) By promising

you will not do these techniques, you are signing off a part of your practice

for all your patients, not just those with ASH insurance. You cannot legally

change your scope of practice from patient to patient based on their insurance

coverage. Washington State Dept of Health states these are safe and legal

practices for acupuncturists. Why should ASH step in and say they aren't?

 

The other complaint I heard from colleagues is that if you accidentally surpass

the alloted 5 or 6 treatment sessions, your contract states that you cannot bill

your patient.

 

They are trying hard to increase their provider base. Perhaps a little boycott

would force them to upgrade and update.

 

Just a few thoughts to consider....

Daniel

 

-

[Guest guest]

I too am interested in how others view insurance.  I am wondering if I should

join insurance as I am a new practitioner.  I have found that some insurance

plans in NY pay $23 to $40 per treatment.  How do practitioners deal with this? 

Are your treatments shorter?  Have the patient come twice a week?  Do the

patients pay seperately for an herbal consult? 

Jen

 

 

Jennifer M. Mohr

Precious Health Acupuncture

361 5th Avenue

Brooklyn, New York 11215

212-228-5522

precioushealth

http://www.precioushealthacup.com

 

--- On Wed, 7/15/09, rdudecat <ronholmes wrote:

 

 

rdudecat <ronholmes

Re: American Specialty Health

 

Wednesday, July 15, 2009, 9:28 PM

 

 

 

 

 

 

, " Dia Vickery " <moonwillow@ ...>

wrote:

>

>

> Has anyone signed up with American Specialy Health and either a) stayed

> because they love it or b) left because it was the worst thing since

> mold or c) any option in the middle I haven't thought of. I'd love to

> hear any opinions, positive or negative, either on list or privately.

 

I signed up with them years ago, when they first started ten years or so ago. It

was a simple procedure then, and reimbursement was pretty good. I took a three

year sabbatical, and, upon returning to practice this year, I tried signing up

again.

My comments:

1. Reimbursement rates have not increased in 10+ years, averaging $40-50 per

session, including all modalities performed--cupping, moxa, tuina, exercise.

2. The requirements, i.e. paperwork, has gone through the roof.

3. I signed up to accommodate my previous clients with insurance coverage, only

to find that many of the insurance plans have dropped coverage, or pay such

little amounts after increasing copays, co insurance, it is hardly worth the

hassle of billing.

4. American Specialty Health has a 30+ page document to follow to determine if

the treatment falls under acceptable clinical guidelines. I think if I truly

followed this, it would consume the entire treatment session. And, I can see

that at any time they could deny care under this complexity of clinical

judgments and evaluations, or require documentation- -another time/money suck.

The basic idea is that the practitioner has 6 treatments to 'cure' the pain

issue. No treatment can be performed that increases the body's function, or is

preventative care. No pain issue can be treated that has an emotional cause,

i.e. stress, that is a major cause in my practice.

5. The requirement that I found the most repulsive, is a long list of medical

procedures that you are required not to do, even if the client pays for it

privately. An example is Reiki. The reasoning is that because this has no proven

medical value, by performing it on a patient, it is considered injurious and

dangerous. You are considered to be leading the patient astray. By following

their clinical guidelines one is reduced to a TCM technician, doing a procedure

of sticking needles into patients in a mechanistic manner.

 

I personally find, on average, patients heal much quicker when they pay cash.

They are more motivated to do the 'homework' I give them, and to try to change

injurious habits. I try to self empower my patients, so they do not become

dependent on a doctor.

Another reason I dislike insurance is that I'm a stickler for privacy, and when

someone tells me of weird or socially unacceptable behaviors or drug usage, I

don't want that entering an insurance database.

 

I'd be interested in how others feel about accepting insurance.

 

Sincerely,

Ronald Holmes LAc.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

I haven't done ASH but having a number of friends in and out of it, from what I

can see a (new) practitioner has a couple of options. If you are going to do ASH

or another type network then be prepared to have most if not all your patients

to come from there. So its not a matter of less time per patient, or each

patient more times, but simply more patients in total.

If you try to have some insurance, some ASH , some private, it is going to be

confusing because you are providing different service at different times of the

day.

If you have other options, such as another type of " network " such as a parents

group, a church group, your hometown etc... and you can draw upon that then you

may not need ASH. If for some reason you can't spend a lot of time in your

office then ASH may not be the best for you either. If however, you have the

time and the organizational skills to see many patients you may be able to use

ASH to your advantage. You may not make a lot per patient but you may end up

with a lot of patients.

Doug

 

 

, Jennifer Mohr <jmm752003 wrote:

>

> I too am interested in how others view insurance.  I am wondering if I should

join insurance as I am a new practitioner.  I have found that some insurance

plans in NY pay $23 to $40 per treatment.  How do practitioners deal with this? 

Are your treatments shorter?  Have the patient come twice a week?  Do the

patients pay seperately for an herbal consult? 

> Jen

>

>

> Jennifer M. Mohr

> Precious Health Acupuncture

> 361 5th Avenue

> Brooklyn, New York 11215

> 212-228-5522

> precioushealth

> http://www.precioushealthacup.com

>

[Guest guest]

A very balanced view of the situation.

 

My input on this issue is simple. If you don't mind giving up most of

your independence in terms of choosing patients, fees, approval of

codes and diagnoses, or selling your own herbs, this model is the one

for you. If you want to work by a model that builds a practice by

your expertise, word of mouth, and pays well, it is not. It is the

difference between being a technician and a Chinese medical

practitioner.

 

 

On Jul 17, 2009, at 8:06 PM, wrote:

 

> I haven't done ASH but having a number of friends in and out of it,

> from what I can see a (new) practitioner has a couple of options. If

> you are going to do ASH or another type network then be prepared to

> have most if not all your patients to come from there. So its not a

> matter of less time per patient, or each patient more times, but

> simply more patients in total.

> If you try to have some insurance, some ASH , some private, it is

> going to be confusing because you are providing different service at

> different times of the day.

> If you have other options, such as another type of " network " such as

> a parents group, a church group, your hometown etc... and you can

> draw upon that then you may not need ASH. If for some reason you

> can't spend a lot of time in your office then ASH may not be the

> best for you either. If however, you have the time and the

> organizational skills to see many patients you may be able to use

> ASH to your advantage. You may not make a lot per patient but you

> may end up with a lot of patients.

> Doug

>

> , Jennifer Mohr

> <jmm752003 wrote:

> >

> > I too am interested in how others view insurance. I am wondering

> if I should join insurance as I am a new practitioner. I have found

> that some insurance plans in NY pay $23 to $40 per treatment. How

> do practitioners deal with this? Are your treatments shorter? Have

> the patient come twice a week? Do the patients pay seperately for

> an herbal consult?

> > Jen

> >

> >

> > Jennifer M. Mohr

> > Precious Health Acupuncture

> > 361 5th Avenue

> > Brooklyn, New York 11215

> > 212-228-5522

> > precioushealth

> > http://www.precioushealthacup.com

> >

>

>

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

C'mon Z'ev... my eyes are rolling up. MEARU(?) Practitioners have proven their

art with more limitations than taking insurance. Of course, one has limitations

with ASH and others but within that structure given I hate to think that the

patient or the money made a bit of difference in the skills applied.

One side of the argument that hasn't been brought up is that many patients have

paid for insurance. Is it fair that those patients don't get the care they

deserve from TCM practitioners? I'm just saying.... One could also say that by

taking insurance, even from these dubious agencies, one is freed from

salesmanship and other illusions.

Doug

 

 

 

 

, <zrosenbe wrote:

>

> A very balanced view of the situation.

>

> My input on this issue is simple. If you don't mind giving up most of

> your independence in terms of choosing patients, fees, approval of

> codes and diagnoses, or selling your own herbs, this model is the one

> for you. If you want to work by a model that builds a practice by

> your expertise, word of mouth, and pays well, it is not. It is the

> difference between being a technician and a Chinese medical

> practitioner.

>

>

> On Jul 17, 2009, at 8:06 PM, wrote:

>

> > I haven't done ASH but having a number of friends in and out of it,

> > from what I can see a (new) practitioner has a couple of options. If

> > you are going to do ASH or another type network then be prepared to

> > have most if not all your patients to come from there. So its not a

> > matter of less time per patient, or each patient more times, but

> > simply more patients in total.

> > If you try to have some insurance, some ASH , some private, it is

> > going to be confusing because you are providing different service at

> > different times of the day.

> > If you have other options, such as another type of " network " such as

> > a parents group, a church group, your hometown etc... and you can

> > draw upon that then you may not need ASH. If for some reason you

> > can't spend a lot of time in your office then ASH may not be the

> > best for you either. If however, you have the time and the

> > organizational skills to see many patients you may be able to use

> > ASH to your advantage. You may not make a lot per patient but you

> > may end up with a lot of patients.

> > Doug

> >

[Guest guest]

Z'ev,

 

I second your statements!!! I have never and will never pander to the

insurance companies, this is, imho, a huge mistake for our field. Ask

doctors (especially the older ones) how they feel about how the insurance

corporations have effected their practice.

 

Thomas

 

A very balanced view of the situation.

 

My input on this issue is simple. If you don't mind giving up most of

your independence in terms of choosing patients, fees, approval of

codes and diagnoses, or selling your own herbs, this model is the one

for you. If you want to work by a model that builds a practice by

your expertise, word of mouth, and pays well, it is not. It is the

difference between being a technician and a Chinese medical

practitioner.

 

 

 

 

Beijing, China

Author of " Western Herbs According to Traditional : A

Practitioners Guide "

Check out my blog: sourcepointherbs.blogspot.com

 

 

 

[Guest guest]

Thomas,

I am trying to find a great article by Richard Brown a few years

ago he wrote for the North American Journal of Oriental Medicine on

how insurance effects the patient/practitioner relationship. He does

a great job of explaining it. . .I think everyone in our field should

read it.

 

 

 

On Jul 19, 2009, at 4:54 PM, wrote:

 

> Z'ev,

>

> I second your statements!!! I have never and will never pander to the

> insurance companies, this is, imho, a huge mistake for our field. Ask

> doctors (especially the older ones) how they feel about how the

> insurance

> corporations have effected their practice.

>

> Thomas

>

> A very balanced view of the situation.

>

> My input on this issue is simple. If you don't mind giving up most of

> your independence in terms of choosing patients, fees, approval of

> codes and diagnoses, or selling your own herbs, this model is the one

> for you. If you want to work by a model that builds a practice by

> your expertise, word of mouth, and pays well, it is not. It is the

> difference between being a technician and a Chinese medical

> practitioner.

>

>

>

>

> Beijing, China

> Author of " Western Herbs According to Traditional : A

> Practitioners Guide "

> Check out my blog: sourcepointherbs.blogspot.com

>

>

[Guest guest]

After moving from the 'any category provider' state of Washington where 95% of

your patients are covered to 'out of pocket' Missouri - I have a good background

on this topic. Sounds like an interesting article. The sub-plot will be 'or,

how financial investment correlates to patient compliance' (that's the PC

title...).

 

That said, if you are a new practitioner staying around your school (like way

too many of us do), in a state that has mandated coverage, then good luck

demanding cash payment. The 'experienced' practitioners get away with a cash

practice in insurance states since they have a name already.

Geoff

 

 

, <zrosenbe wrote:

>

> Thomas,

> I am trying to find a great article by Richard Brown a few years

> ago he wrote for the North American Journal of Oriental Medicine on

> how insurance effects the patient/practitioner relationship. He does

> a great job of explaining it. . .I think everyone in our field should

> read it.

>

>

>

> On Jul 19, 2009, at 4:54 PM, wrote: